Highways Department 路政署

Application Form for Registration as HyD Suppliers 路政署供應商註冊申請書

P.1

Our Ref.: 本署檔號：

This form should be completed in FULL and must be returned by registered mail to: 請填妥本申請書的每一個部分，並以掛號方式寄回：

SUPPLIES SECTION 香港北角渣華道 號HIGHWAYS DEPARTMENT 北角政府合署 8 樓 8/F., NORTH POINT GOVERNMENT OFFICES 路政署物料供應組 333 JAVA ROAD, NORTH POINT, HONG KONG

333

PART I – DETAILS OF THE COMPANY 第一部 — 公司資料

1. Name of Company: English (英文) Chinese(中文)

公司名稱：

2. (1) Main Office: Tel. No.電話號碼

Fax No.

傳真號碼 English Address:英文地址：

Chinese Address: 中文地址：

(2) E-mail address (if applicable): 電郵地址 (如適

用)：

3. Nature of Business:業務種類：

4. How long in present business? 經營現時業務已多

久?

P.2

PART II – ORGANIZATIONS AND STAFF 第二部 — 公司組織及職員資料

1. Members of Organization holding executive functions :公司內行政人員：

English Name(英文姓名): Chinese Name (中文姓名): (1) Managing Director:

常務董事： * Mr./Miss/Ms. 先生／小姐／女士

* Mr./Miss/Ms. 先生／小姐／女士

(2) Directors :董事：

* Mr./Miss/Ms. 先生／小姐／女士

* Mr./Miss/Ms. 先生／小姐／女士

(3) Owners/Proprietors:擁有人／東主：

* Mr./Miss/Ms. 先生／小姐／女士

* Mr./Miss/Ms. 先生／小姐／女士

(4) Partners:合夥人：

* Mr./Miss/Ms. 先生／小姐／女士

* Mr./Miss/Ms. 先生／小姐／女士

* Delete where inappropriate(請將不適用者刪去 )

2. Total number of staff employed: 聘用職員總數：

. Authorized persons (at least 2) to contact on matters relating to quotations/tenders/contracts: 獲授權回答有關報價／投標／合約等問題的人士 (最少兩名 )：

Name(s) 姓名

Official Capacity職位

Tel. No.電話號碼

*Mr./Miss/Ms. 先生／小姐／女士

*Mr./Miss/Ms. 先生／小姐／女士

* Delete where inappropriate(請將不適用者刪去 )

P.3

PART III – BUSINESS ACTIVITIES 第三部 — 業務狀況

1. Detailed list of goods/ services which your company can provide. (Please enclose relevant catalogues/descriptive literature for consideration).

請詳細列明貴公司所供應的貨品／提供的服務。 (請一併遞交有關目錄／詳細說明書，以供本處參閱。 )

(Note: If space is not sufficient, please use separate sheet) (註：如空位不敷應用，請另備紙張填寫 )

2. Please provide the name(s) of the principal(s) for whom you act as the accredited agent(s) /distributor(s) in case you are not the manufacturer and a list of their products represented by you in Hong Kong:倘若貴公司並非製造商，請提供授權貴公司為代理商／分銷商的商號名稱和該等商號委託貴公司在香港代理的產品

目錄：

(Note: If space is not sufficient, please use separate sheet)

(註：如空位不敷應用，請另備紙張填寫 )

3. The names, addresses and contact persons of local firms (preferably five numbers) to whom you have supplied stores/ provided services and who would be prepared to provide, if required, references in respect of the orders/ service contracts which you have undertaken with them.

曾獲貴公司供應物料／提供服務的本地客戶名稱、地址和聯絡人姓名 (以填寫五個為宜)。該等商號須願意於本署要求

時，提供貴公司所履行定單／服務合約的有關參考資料：

Name and Address名稱及地址

Contact Person 聯絡人 Stores Supplied/

Services Provided

所供應的物料／提供的服務 English Name

英文姓名

Chinese Name

中文姓名 (1)

(2)

(3)

(4)

P.4 (5)

Remarks : It is your responsibility to notify the above companies that they have to give comments on your contract performance as soon as possible upon receipt of our questionnaires.

備註：貴公司有責任通知上述公司在收到本署發出的問卷後，就貴公司履行合約的表現盡快給予評價。 (Note: If space is not sufficient, please use separate sheet)

(註：如空位不敷應用，請另備紙張填寫)

PART IV – DOCUMENTS 第四部 — 證明文件

Please submit the following documents for reference and record: 請一併寄交下列文件各一份，以供本署參考和備案：

(For Office Use Only) (此欄祇供有

關部門填寫 ) (1) * A copy of a valid Business Registration Certificate (BRC).

有效的商業登記證副本。

(2) A copy of Certificate of Incorporation (for body corporate only e.g. limited company).公司註冊證書副本 (祇適用於法人團體，例如有限公司 )。

(3) Memorandum and Articles of Association (for body corporate only e.g. limited company).公司組織章程大綱及細則 (祇適用於法人團體，例如有限公司 )。

(4) Company profile and annual report. 公司簡介及年報。

*For Rehabilitation non-government organizations, please submit the letter certifying your organization is a charitable institution issued by the Inland Revenue Department for verification purpose. 如屬提供更生服務的非政府機構，請遞交由稅務局發出證明貴機構為慈善機構的函件副本，供本署核實。

PART V – CERTIFICATION 第五部 — 核證

I apply on behalf of the company to register as a HyD supplier and certify that the information provided from PART I to PART IV above is correct and accurate. 本人謹代表本公司申請註冊為路政署供應商，並證明第一至第四部所填寫的資料全屬確實無誤。

Signature:簽署: Name in Block Letters:姓名 (正楷): Designation: 職銜:

(Space for Company Chop) (公司印鑑 )

Date:日期:

Change of Address更改地址

In case there is a change in your company address, please notify the Supplies Section, Highways Department, 8/F., North Point Government Offices, 333 Java Road, North Point, Hong Kong, to amend your address record. 倘若貴公司的地址有所更改，請通知路政署物料供應組 (地址為香港北角渣華道 333 號北角政府合署 8 樓)，以便更改

貴公司的地址記錄。

P.5

NOTES FOR GUIDANCE 備註

Purpose of Collection 收集資料用途

The personal data provided by means of this form will be used by the Highways Department for consideration on the application for HyD supplier registration for tender / quotation invitation.

填報在此表格內的個人資料供路政署審批註冊為路政署供應商的申請之用，以便本署日

後向註冊供應商招標／要求註冊供應商報價。

Transfer of Data資料轉介

The personal data you provide by means of this form may be disclosed to other government departments or non-government public entities.

本署可能會向其他政府部門或非政府部門的公共機構，披露此表格所填報的個人資料。

Access of Personal Data索閱個人資料

You have the right of access and correction with respect to personal data as provided for in sections 18 and 22, and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain a copy of your personal data provided by this form.

根據《個人資料(私隱)條例》第 18、22 條及附表 1 第 6 原則，你有權索閱或修訂個人資

料，包括索取此表格所填報資料的副本。

Enquiries查詢

Enquiries concerning the personal data collected by means of this form, including the making of access and corrections, should be addressed to:

如欲查詢此表格內的資料，包括查閱途徑及修訂資料，請與下述辦事處聯絡：

SUPPLIES SECTION HIGHWAYS DEPARTMENT 8/F., NORTH POINT GOVERNMENT OFFICES, 333 JAVA ROAD, NORTH POINT, HONG KONG

香港北角渣華道 333 號北角政府合署 8 樓路政署物料供應組

Fax: (852) 2383 7073 傳真： (852) 2383 7073

HyD Sup Reg. (Version 1_7.14)